Tracking Diabetes with MyNetDiary

Katherine Isacks, MPS, RD, CDE

Welcome to MyNetDiary Diabetes Tracker! This article will help you use it to its fullest - as a powerful diabetes tracking tool. Tracking helps identify relationships between blood glucose, weight, exercise, medication, and food and beverage intake. Once these relationships are understood, you can analyze, plan, and implement behavioral changes to better control your blood glucose levels, and therefore, diabetes. Controlling diabetes is especially important to reduce risk of complications related to the nerves, feet, skin, kidneys, and eyes.

If you haven't read the Diabetes Basics article, we highly recommend reading it first for background information on diabetes and management strategies.

I hope that after reading Diabetes Basics, you are now convinced of the importance of diabetes tracking, balancing food, exercise, and medications to improve blood glucose control and achieve your optimal health.

MyNetDiary Diabetes Tracker is built from the ground up to store and organize your carb intake, medication, exercise, blood glucose, and other physical parameters all in one place, providing charts, overviews, and reports based on the information you track.

Tracking Online on the Web, the iPhone App, or Both

Diabetes website and iPhone screenshots

MyNetDiary Diabetes Tracker is available online on the MyNetDiary website for Maximum members and also as an iPhone app. Both the website and the iPhone app have similar tracking functionality.

The iPhone app optionally backs up data to the web and syncs up when a connection is available. The iPhone app helps you make your tracking consistent, since it is mobile and at your fingertips.

For Maximum members, the website provides all the tracking features the iPhone app has, and also extends functionality in several important areas. You can view charts and reports on a large screen, enter all tracking data efficiently using keyboard and mouse, combine several charts to see them together, use more chart and reporting options (including printing). The website allows optional sharing of your diary with others, provides internet-enabled integration with Withings and Fitbit and offers community forum participation.

Tip: Each web page on the site has a “Help” link, providing additional information, guidelines, and tips. Each screen in the Diabetes Tracker iPhone app also has a “Help” button. Make sure to use them!

The Nitty Gritty: Even if you are planning on using only the iPhone app, set up an online account.

Although the app can be used without an online account, I strongly urge you to set up an account so that your data lives on a server at MyNetDiary rather than just on your mobile device. MyNetDiary will not spam or sell your contact information so please take advantage of this feature. Setting up an account allows you to login to multiple devices as well as the website and enter foods and exercise online, even with a free MyNetDiary account (you can do much more with MyNetDiary Maximum). And most importantly, losing your phone doesn't mean losing all of your valuable diabetes data!

Tracking Blood Glucose

iPhone blood glucose tracking features

Once you enter your blood glucose readings, Diabetes Tracker will help you quickly identify high and low readings on reports and charts. Diabetes Tracker has flexible target ranges (targets can be set for any testing condition), including auto-assigned lows and highs. When your blood glucose entry is above or below assigned targets, they show up highlighted on reports and charts so you cannot miss them.

The terms you use to describe those readings (e.g. “fasting” or “before bed”) are termed “labels”. You can set up target ranges with labels as well as auto-assign labels for high and low blood glucose cut-offs in either the web program or the app.

Note: At this time, MyNetDiary does not provide integration with blood glucose meters, as this would make it a Class 2 Medical Device and require FDA review and approval.

Web. Your blood glucose readings are considered tracker entries - the tracker is “Blood Glucose”. You can add, view, or modify your Blood Glucose tracker in “Daily Tracking”. Add a blood glucose reading by clicking “Add entry”. You can customize your blood glucose target ranges by clicking “Customize Trackers”. For your convenience, the tracker Blood Glucose has default target ranges set up for you: 70-140 mg/dL before meals, 70-160 mg/dL after meals, 100-140 mg/dL before bed, < 70 mg/dL for hypoglycemia (low blood glucose), and > 200 mg/dL for hyperglycemia (very high blood glucose). Of course, you can edit these values to match your personalized goals determined by you and your doctor and/or diabetes educator. Target ranges affect how your values are displayed on reports and charts — similar to how charts are displayed on printouts downloaded from blood glucose meters or insulin pumps.

Mobile App. The app has a special Blood Glucose row on the Home screen, showing your daily averages and opening up a special Blood Glucose screen for entering blood glucose readings. To customize your blood glucose target ranges as well as hypoglycemia (low) and hyperglycemia (high) cut-offs, use the gear icon on this screen. As in the web program, these goals and cut-offs affect how your blood glucose values are displayed on reports and charts. If you prefer using a large screen to set up your trackers and target ranges, then no worries - as long as you login into your app using your online account you will see all customizations and changes you made in the web program.

The Nitty Gritty: Labels for Your Blood Glucose Entries

Once you have entered a blood glucose reading from your meter, a label can be assigned to that entry. Labels are descriptions — they serve to make entries more meaningful to you. You do not need to assign a label to every tracker value, but I strongly urge you to consider labeling all of your blood glucose entries so that you don't have to guess under what conditions you tested (e.g. fasting, before breakfast, feeling low, etc.). Our labels are similar to the labels you see in your blood glucose meter, except that we have many more options and you can also create your own labels.

You are not limited to one label — you can assign multiple labels to a tracker value if you wish. For instance, you can assign your fasting blood glucose reading with both “fasting” and “before breakfast” labels. Or, maybe you felt like you had low blood glucose when you tested before dinner — you could assign that value two labels: “feeling Low” and “before dinner”.

Web. If you want to see labels that have already been created for your use, click “Label Catalog”. You can use any label you wish on any tracker. If you do not see what you want, you can create your own label in “Custom Labels”.

Mobile App. As with the web, you have access to many labels that have already been created for your use. However, in the app you will first see the most commonly used labels rather than the entire list. As you use labels, they will also show up on the list of choices. If you do not immediately see a label you wish to use, just type it in the search box and similar to a food search, selections will immediately pop up that match your search criteria. If you do not see what you want, you can add your own custom label right there.

Tip: If you want your app's home screen to display accurate pre-meal and post-meal blood glucose averages, then be sure to use the appropriate built-in labels rather than creating your own. Pre-meal will average all blood glucose entries if they are assigned these labels: before breakfast, before lunch, before dinner, and before snack. Post-meal will average all entries if they are assigned these labels: after breakfast, 2h after breakfast, after lunch, 2h after lunch, after dinner, 2h after dinner, after snack, and 2h after snack.

The Nitty Gritty: Blood Glucose Reports & Charts

Reports: Diabetes Overview

iPhone Diabetes Reports

To view your daily tracker values (e.g. Blood Glucose, Insulin, Medications, and Exercise) over the course of the day, view “Diabetes Overview” in your app or in your online account under Diabetes tab. This view is organized into seven time periods, starting with midnight and ending with 11:59 PM. Because tracker values are grouped into specific time periods, day after day, it is easy to see how your blood glucose values are changing over days within the same time period. A nifty feature is that you can toggle between viewing your day's view or your weekly view. Weekly View is extremely helpful when you want to see changes over time, especially with a recent change to medication dose.

Web. If you like the big screen experience and prefer to look at tracker values for the day and over the course of a week all at once, be sure to view the “Diabetes Overview” on the web. To scroll through days in the web program, just page down to go backwards in time. You can also print detailed reports with varying time periods either directly to a printer or you can export to Excel or HTML.

Mobile App. Tapping “Diabetes Overview” jumps you into the current time period. To view other time periods within the same day, just swipe your finger to the right or left to go forwards or backwards in time. To scroll through days, tap the horizontal arrows to go forward or backward in time while staying within the same time period (e.g. 6 PM — 8:59 PM).

Charts

To see a nice, large graph of your blood glucose readings over time, “Diabetes Charts” on the web gives you the best view as well as the capability to print. As you scroll vertically down the page, you will see graphs of macronutrient intake, exercise, medications, and other items you have chosen to track.

In the iPhone app you can also see the graphs in “Charts” row, but the view is smaller and you cannot print from the app screen. Still, it gives you a quick visual representation of your blood glucose readings and out of range values are easily spotted.

Carb Counting

You are no longer stuck with those limited and awkward carb counters that some meters or pumps provide for carb counting, nor do you have to purchase a carb counting book. Diabetes Tracker has a high-quality, large 330,000 food database that can be extended with your own custom-entered foods and recipes. Or, with your iPhone (or iPod if it has a camera) you can use PhotoFood Service to have MyNetDiary staff enter or correct a food item for you. This grows the database with quality control.

The iPhone app has a built-in barcode scanner, working on iPhone 3GS and later. Using a packaged food? Pick the right food by using your iPhone app to scan the barcode on the food package.

For veteran MyNetDiary users, entering meals and snacks is the same. However, there are a few safety features implemented for Diabetes Tracker, as well as some tips that you might find helpful.

Food time tracking. Use this feature so that the system totals your carbs by meals and snacks correctly. If you enter meals and snacks earlier or later than the actual time consumed, then be sure to enter the correct time stamp for your entry. MyNetDiary provides four types of meals, but snack foods eaten within one hour will be grouped together, so you will have separate carb counts for as many snack meals as you need. If you are a late night eater, then remember that the day changes at 12 AM. If you prefer to see your foods grouped together on the previous day (and you ate close to midnight), then you could simply choose to log your intake at 11:59 PM. If food time tracking is not displayed, you can turn it on in Settings.

Carbs quick view. For your safety and convenience, you can quickly view a food item's carb count in the app during food entry, without having to tap to view the Nutrition Facts panel. This allows you to quickly check that you have chosen the appropriate food item and serving size (and therefore, carb count) before logging the item. If you do not see a carb count on your food item screen in your app, then go into Settings and in the “Show Carbs” row, tap the on/off toggle to display “On”.

Choose the correct food item. Be sure to check the carb count of the food you are selecting. For instance, there is a big difference in the carb count between Dannon's Light & Fit Strawberry Yogurt (10 g total carbs) vs. Dannon's Fruit on the Bottom Low Fat Strawberry Yogurt (30 g total carbs). Make sure you select the right food, even if you use the built-in barcode scanner. Occasionally, a food is out of date or the pack size changes and affects the portion size.

Double check your serving size. Entering an incorrect portion size can throw off your carb count and make it inaccurate - either too high or too low.

Once again, always check the carb count against the Nutrition Facts panel (food label) to make sure you selected the correct food item, portion size, and the nutrition facts are correct.

User contributed foods. To ensure higher carb count accuracy, foods entered by others (user contributed) are hidden from view. Your existing custom-entered foods are all still available if you are a MyNetDiary member who has upgraded to Diabetes Tracker. If the food you ate is not in the database, you can either create a custom food and enter the nutrients yourself, or using the awesome PhotoFood Service, take photos of the package and Nutrition Facts so that MyNetDiary staff will enter the data for you. PhotoFood Service for Diabetes Tracker app allows you to enter carbs in addition to calories, to ensure correct carb count while PhotoFood Service processes your request.

The Nitty Gritty - Diabetes Settings for Carb Counting

Tracking carbohydrates with MyNetDiary Diabetes Tracker is unique — you have the choice of three different types of carb totals to track: Total Carbs (as listed on Nutrition Facts panels), Net Carbs (Total Carbs — Fiber — Sugar alcohols), or Diabetes Carb Count (Total Carbs − ½ (fiber if ≥ 5 grams/serving) − ½ (sugar alcohols if ≥ 5 grams/serving). Diabetes Carb Count is the type of carbohydrate counting used by the International Diabetes Center and the American Diabetes Association. It is considered to be a more accurate method of counting carbohydrates if one uses an insulin to carbohydrate ratio to determine their dose of rapid-acting insulin at meals. Total Carbs will give the highest carb count whereas Net Carbs will give the lowest carb count.

Safety Tip: Diabetes Tracker counts carbohydrate grams from ALL FOODS. This means that the carb count is going to be higher with mixed meals than if you manually counted carbs from only the major carbohydrate-containing food groups (i.e. starches, sweets, milk, and fruit). If you are new to using a device to count carbs and you use an insulin to carb ratio, then your ratio might need to be adjusted so that 1 unit of insulin covers more grams of carbs. But let your blood glucose readings be the judge — your post meal blood glucose readings will inform you if your insulin to carb ratio is still appropriate or not. If you have always counted carbs from all food groups, then no change to your insulin to carb ratio is anticipated. Please consult your diabetes care team if you need help adjusting your insulin to carb ratio.

Insulin Tracking

iPhone insulin tracking

For those who need insulin, MyNetDiary provides a special insulin tracker. If you don't need it, you can turn off insulin tracking in Settings.

App Tip: If you use insulin but do not see it in your app as the second row on your home screen, then go into your Diabetes Settings and tap “On” for “Show Insulin”.

There are tons of insulin brands already set up for you to use, but if you do not see the type of insulin you use in “Select Insulin,” then you can customize your own tracker by selecting “Create Custom Insulin” (mobile app) or “Add Insulin” (web).

You can track more than one type of insulin. After you choose which types of insulin to track, enter your dose by tapping the insulin row and then type of insulin. Enter the dose and correct time of dose. You do not have to assign a label to your insulin dose, but you can if you feel that the time stamp is not enough of a description. If you want to add a lengthier description, then use the “Notes” field ( just below the label field).

For those of you who manually mix your insulins (e.g draw up rapid acting-first, and then draw up intermediate-acting in the same syringe), you can decide how you want to track the two insulins. The safest way to track is to choose to track both insulin types so that the correct dose and time for each is displayed. For instance, if I take 5 UNITS of Humalog and 12 UNITS of NPH, then I would enter Humalog dose of 5 UNITS and another dose of 12 UNITS NPH, both with the same timestamp. However, if that is a nuisance, then you can simply create a custom insulin tracker with a name that includes both insulins, and in the order that you draw up the insulin (e.g. Humalog + NPH), and MyNetDiary's insulin type MIX. When you enter your dose, always enter the total UNITS. For my example of 5 UNITS of Humalog and 12 UNITS of NPH, I would enter my dose as “17”. Do not enter the dose as “5/12” since the system will assume it is one number (e.g. “5/12” will show as “0.417” which is not a safe way to log a two separate doses of insulin!

For reporting and later analysis and learning, it is most important that you enter the correct dose and time that you took your insulin.

Exercise

Ever wonder how exercise affects your blood glucose? Stop relying on memory - now you have a specific tool to help you see relationships between exercise time and intensity and blood glucose control. In addition to calories burned, exercise entries contain exercise description, amount, time of the day and user notes. For experienced MyNetDiary users, exercise logging remains the same except for the option of including a time stamp. I strongly urge you to use a time stamp for all exercises so that you can see how it affects blood glucose readings.

Medications & Other Important Trackers

In addition to tracking blood glucose, insulin, carbs, and exercise, you can also track oral and injectable medications, heart rate, blood pressure, blood lipids, and Hemoglobin A1C. You can also track “Comments” if you wish - this might be a good place to track your perceptions of stress on a daily basis. You can also create your own custom trackers. If you set up trackers on the web, then they will carry over to your app as long as you login into your account.

Web. You can add, view, or modify trackers in “Daily Tracking”. Once your trackers are selected, you simply add a value by clicking “Add entry”. You can customize target goals or ranges for those trackers by clicking “Customize Trackers”.

Mobile App. Medications has its own row on the home screen. Once you tap that row, you can select the medications you wish to track. If you have already set up your medication trackers on the web, they will show up in this row. Once the medication is selected for tracking, you simply tap the medication name to add your dose, time, and assign an optional label or write notes about the dose if you wish.

To select other trackers (e.g. blood pressure), tap the “Trackers” row on the home screen. Tap the gear icon on the lower left hand corner and select what you wish to track. You can define a target value too (e.g. 130/80 for blood pressure). Please be sure to use targets that your doctor and/or diabetes educator has established for you. For instance, many folks with diabetes use these goals:

  • Blood pressure < 130/80 mmHg
  • Total cholesterol < 200 mg/dL
  • LDL < 100 mg/dL (or < 70 mg/dL if previous history of heart attack)
  • HDL women > 50 mg/dL; men > 40 mg/dL

Once a tracker is selected, you can enter your reading, time, assign a label or write notes about it.

Hemoglobin A1C. Please consider including this predefined tracker - it is the strongest predictor of certain diabetic complications. The American Diabetes Association recommends A1C testing every 3 months until target is achieved. For most folks, that is < 7% but please follow your doctor's recommended target which might be higher or lower.

Ketones. You can track ketones as a custom tracker. Tracking ketones is especially important when you are sick, your blood glucose readings are very high, and/or when you are pregnant.

These tests are also important in your management of diabetes and all of these can be added as custom trackers:

  • Kidney function (e.g. serum creatinine)
  • Foot exam
  • Dilated eye exam
  • Dental exam
  • Flu vaccine
  • Cigarettes

Trying to Eat Heart Healthy? Utilize Nutrient Planning

Diabetes Tracker provides macronutrient planning as well as setting daily target values for up to 40 nutrients. Following a heart healthy meal plan is extremely important given that people with diabetes have a double to triple higher risk of cardiovascular disease. Default goals are consistent with the American Heart Association and the American Diabetes Association guidelines. Nutrient goals can also be edited to suit your personalized plan. For veteran MyNetDiary users, this functionality is the same.

As with MyNetDiary, Diabetes Tracker displays the nifty Daily Analysis and Weekly Analysis views in Analysis row in the app, and in the Details tab on the web. The Analysis screen highlights both your calories status for the day as well as provides a quick snapshot of your current nutrient intake compared to specific goals. For instance, eating a breakfast meal, getting enough fiber at breakfast, and limiting problem nutrients overall (trans and saturated fats, cholesterol, and sodium). This screen also toggles to a weekly summary of highlights. Weekly Summary is super nifty in that it also tells you how many days you tracked and which meals were missing. This makes correcting your food record very easy.

Important safety issue: MyNetDiary default nutrient goals are NOT APPROPRIATE for those with diabetes who have kidney disease. Those with kidney disease must use nutrient goals recommended by their health care team.

Weight Control

MyNetDiary was originally designed to help a person lose weight. Losing weight and avoiding weight regain is especially important for those who have prediabetes or Type 2 diabetes since it improves insulin sensitivity and blood glucose control. Diabetes Tracker has a flexible calories and macronutrient planner, supported by Daily and Weekly Analysis feedback. An “autopilot” feature on the web Plan page allows automatic plan adjustments so that you achieve your target weight by your target date.

Community

You can choose to share your data with others in the Community, find peer support, join groups and teams, or simply post questions or reflections on forum threads. If you want to post a specific question to me, a Registered Dietitian (RD) and Certified Diabetes Educator (CDE), then be sure to post it on Ask a Dietitian forum topic. I love hearing from folks!

You can also share customized recipes and foods, and your weight data by updating settings in “My Community Profile” via Community tab in the web program. The default setting is to hide everything from view. You can choose to share data with only specific members or you can share with the entire MyNetDiary Community.

If you are curious, you can click on my nickname (“Dietitian”) to view the type of data that can be seen if you share all data. I choose to share my name since I moderate the forum, but most folks do not display their full names due to privacy.

English vs. Metric Units

MyNetDiary supports English and metric units for weight and height. For blood glucose readings, both mg/dL and mmol/L are supported. Kilojoules can be selected in iPhone app settings. For clock settings, iPhone app uses your iPhone settings, and on the website you can select 12-hour vs. 24-hour clock in Account tab (Personal page).

Enjoy using your new Diabetes Tracker!

If you have questions or comments about your tracking experience, please feel free to comment in MyNetDiary Community Forum or MyNetDiary Facebook page. I would love to hear from you!

Disclaimer: Please note that we cannot provide personalized advice and that the information provided does not constitute medical advice. If you are seeking medical advice, please visit a medical professional.

More Resources

This article can be found at http://www.mynetdiary.com/tracking-diabetes-with-mynetdiary.html